Chronic Low HDL

[boxstermike]

I have a question for the group, since my physician seems to be stumped about what to do.

I have had chronically low HDL (15-30) for the last ten years.  I have been taking 2000mg Niaspan daily for the last 18months, helping to raise it from 25 to 30.  I run about 9miles a week, work out 3-4X at the gym each week, and drink a glass of red wine every night.  I eat nuts every day, take Omega3, and rarely eat red meat - subscribing to a low cholesterol diet.  Weight is 185 at 6'3", age 50.   LDL is always pretty low - most recently 66.

I recently had another VAP test with the following red flags:
HDL-2  is 5 (rec >10)
HDL-3  is 26 (rec >30)
VLDL-3 (remant lipo) at 15 (rec <10)
LDL size pattern is "B" (far from A/B)
Triglycerides at 187 (high)

Also, BP is borderline averaging (over 30 days) around 130-135/80

Questions:
- What other ideas are there to raise HDL?
- What is effective lowering VLDL3?
- What would help moving the LDL size pattern toward "A"?
- What is the most important thing to address/focus on?
- Should I even worry about it?

Thanks!!

[boxstermike]

Thanks for the comments.  However, Carbs can't be it.  I avoid sugar like the plague (diabetes runs in the family) and carbs (weight) except for the aforementioned glass of wine a day. When I do drink a soda (which is rare) they are diet.  Sugars are generally from natural sources (fruit every day).  Yes, there might be the occassional lapse (maybe a pizza once a month), but no regular high carb intake.

Interesting about the Ezetimibe.  I'll check it out since statins are out (due to interaction with Niaspan).

Thanks again,

[ed34]

I had the same problem. I had low LDL but also low HDL and hight triglycerides. I was
taking 40mg of Atorvastatin a day but diagnosed with hypercholesterolemia. My
Cardiologist added 10mg Ezetimibe to my regime and it acted like a turbo booster to my
statin. Within a week my LDL was lower still, my HDL raised and my Trigs lowered right
down. Statins work on the Liver, Ezetimibe works on the Digestive tract to prevent so much fat being absorbed.

[NTB]

yes, you should worry about the high triglycerides and low HDL. Remember Tim Russert?

you have the typical pattern of a high-carb intake, perhaps especially sugar. High triglycerides can suppress HDL, and are associated with high VLDL. Also, high carb and low fat is what causes the preponderance of small dense LDL.

The wine might help raise HDL a little bit, but will raise triglycerides even more. I'd ditch it, even though moderate alcohol is generally cardioprotective for most others. I am not a low-carb dieter myself by any means, but it's uncanny how the low-fat / high-carb seems to be going wrong for you. Maybe a steak would indeed do you good. Saturated fat would also tend to raise HDL.


Did you know that the theory that keeping saturated fat and cholesterol low (to prevent artery disease) is not actually proven? Others might do well on a low fat, high carb diet but it doesn't seem to be good for you.

Do you drink a lot of sodas, or get fructose otherwise?

http://www.youtube.com/watch?v=dBnniua6-oM

you can fast forward to ~ minute 35